背景与目的云南东部农村地区宣威市、富源县女性居民主要从事农业生产和家务工作,基本不吸烟,但肺癌死亡率却是世界上最高的,而且发病、死亡年龄提前。本研究对宣威、富源非吸烟女性肺癌生存状况及其影响因素进行分析。方法以2006年-201...背景与目的云南东部农村地区宣威市、富源县女性居民主要从事农业生产和家务工作,基本不吸烟,但肺癌死亡率却是世界上最高的,而且发病、死亡年龄提前。本研究对宣威、富源非吸烟女性肺癌生存状况及其影响因素进行分析。方法以2006年-2010年被当地省、市、县9家医院新诊断、并纳入"非吸烟女性肺癌病例对照研究项目"的常住户籍女性肺癌病例为研究对象随访至2016年末。通过Life-table法进行全部病例生存分析,评估人群相对生存率和年龄别标化相对生存率。应用Kaplan-Meier法和Cox比例风险模型分别进行单因素生存分析、分层分析和多因素分析。结果随访的1,250例病例中,死亡1,075例,删失175例,随访中位时间为69个月(95%CI:61.9-76.0)。病例平均年龄(54.8±10.9)岁,I期、II期、III期、IV期和未知分期分别占3.5%、8.7%、20.7%、29.7%和37.4%;手术、非手术治疗和未治疗分别占17. 2%、39.0%和43. 8%,组织学、细胞学诊断占51.6%。中位生存时间13.2个月,5年观察生存率、相对生存率、年龄标化相对生存率分别为8.9%(95%CI:7.0-10.6)、9.4%(95%CI:7.6-11.5)和10.1%(95%CI:3.7-20.5)。I期、II期、III期、IV期、未分期5年生存率分别为41.1%、22.4%、5. 3%、1. 3%、11.2%;手术治疗、非手术治疗、未治疗分别为34.8%和3.2%、4.7%;腺癌、鳞癌分别为17.9%和5.6%。省级医院治疗、X线胸部筛查、非农民职业、城镇居住、65岁以下年龄等因素有利于提高生存率,而市县级医院治疗、农民职业、乡村居住、65岁以上年龄等则生存率较低。分层分析显示,任意原发灶-淋巴结-远处转移(tumornode-met a st a si s,T N M)分期,无论腺癌或鳞癌患者,行手术治疗的生存率明显高于非手术治疗;与未治疗病例相比非手术治疗仅在III期显示差异;腺癌生存率大于鳞癌不仅仅因为早期和手术病例较多,在III期、未分期也显示明显生存优势。不同级别医院治疗疗效有明显差异,省级医院治疗的IV期、鳞癌的生存预后明显优于市、县级医院。Cox分析显示治疗方法、TNM分期、治疗医院级别、X线胸部筛查是独立预后因素,其中TNM分期、手术治疗对肺癌患者生存影响较大,而治疗医院级别、X胸部筛查相对较弱。结论宣威、富源非吸烟女性肺癌生存率较低,主要与其诊断时早期病例和手术、综合治疗较少、而未治疗病例较多有关,其次较差的农村社会经济、健康保障等也是生存预后的不利因素。展开更多
Over half of the world's population is exposed to household air pollution from the burning of solid fuels at home. Household air pollution from solid fuel use is a leading risk factor for global disease and remain...Over half of the world's population is exposed to household air pollution from the burning of solid fuels at home. Household air pollution from solid fuel use is a leading risk factor for global disease and remains a major public health problem, especially in low- and mid-income countries. This is a particularly serious problem in China, where many people in rural areas still use coal for household heating and cooking. This review focuses on several decades of research carried out in Xuanwei County, Yunnan Province, where household coal use is a major source of household air pollution and where studies have linked household air pollution exposure to high rates of lung cancer. We conducted a series of case-control and cohort studies in Xuanwei to characterize the lung cancer risk in this population and the factors associated with it. We found lung cancer risk to vary substantially between different coal types, with a higher risk associated with smoky(i.e., bituminous) coal use compared to smokeless(i.e., anthracite) coal use. The installation of a chimney in homes resulted in a substantial reduction in lung cancer incidence and mortality. Overall, our research underscores the need among existing coal users to improve ventilation, use the least toxic fuel, and eventually move toward the use of cleaner fuels, such as gas and electricity.展开更多
文摘背景与目的云南东部农村地区宣威市、富源县女性居民主要从事农业生产和家务工作,基本不吸烟,但肺癌死亡率却是世界上最高的,而且发病、死亡年龄提前。本研究对宣威、富源非吸烟女性肺癌生存状况及其影响因素进行分析。方法以2006年-2010年被当地省、市、县9家医院新诊断、并纳入"非吸烟女性肺癌病例对照研究项目"的常住户籍女性肺癌病例为研究对象随访至2016年末。通过Life-table法进行全部病例生存分析,评估人群相对生存率和年龄别标化相对生存率。应用Kaplan-Meier法和Cox比例风险模型分别进行单因素生存分析、分层分析和多因素分析。结果随访的1,250例病例中,死亡1,075例,删失175例,随访中位时间为69个月(95%CI:61.9-76.0)。病例平均年龄(54.8±10.9)岁,I期、II期、III期、IV期和未知分期分别占3.5%、8.7%、20.7%、29.7%和37.4%;手术、非手术治疗和未治疗分别占17. 2%、39.0%和43. 8%,组织学、细胞学诊断占51.6%。中位生存时间13.2个月,5年观察生存率、相对生存率、年龄标化相对生存率分别为8.9%(95%CI:7.0-10.6)、9.4%(95%CI:7.6-11.5)和10.1%(95%CI:3.7-20.5)。I期、II期、III期、IV期、未分期5年生存率分别为41.1%、22.4%、5. 3%、1. 3%、11.2%;手术治疗、非手术治疗、未治疗分别为34.8%和3.2%、4.7%;腺癌、鳞癌分别为17.9%和5.6%。省级医院治疗、X线胸部筛查、非农民职业、城镇居住、65岁以下年龄等因素有利于提高生存率,而市县级医院治疗、农民职业、乡村居住、65岁以上年龄等则生存率较低。分层分析显示,任意原发灶-淋巴结-远处转移(tumornode-met a st a si s,T N M)分期,无论腺癌或鳞癌患者,行手术治疗的生存率明显高于非手术治疗;与未治疗病例相比非手术治疗仅在III期显示差异;腺癌生存率大于鳞癌不仅仅因为早期和手术病例较多,在III期、未分期也显示明显生存优势。不同级别医院治疗疗效有明显差异,省级医院治疗的IV期、鳞癌的生存预后明显优于市、县级医院。Cox分析显示治疗方法、TNM分期、治疗医院级别、X线胸部筛查是独立预后因素,其中TNM分期、手术治疗对肺癌患者生存影响较大,而治疗医院级别、X胸部筛查相对较弱。结论宣威、富源非吸烟女性肺癌生存率较低,主要与其诊断时早期病例和手术、综合治疗较少、而未治疗病例较多有关,其次较差的农村社会经济、健康保障等也是生存预后的不利因素。
文摘Over half of the world's population is exposed to household air pollution from the burning of solid fuels at home. Household air pollution from solid fuel use is a leading risk factor for global disease and remains a major public health problem, especially in low- and mid-income countries. This is a particularly serious problem in China, where many people in rural areas still use coal for household heating and cooking. This review focuses on several decades of research carried out in Xuanwei County, Yunnan Province, where household coal use is a major source of household air pollution and where studies have linked household air pollution exposure to high rates of lung cancer. We conducted a series of case-control and cohort studies in Xuanwei to characterize the lung cancer risk in this population and the factors associated with it. We found lung cancer risk to vary substantially between different coal types, with a higher risk associated with smoky(i.e., bituminous) coal use compared to smokeless(i.e., anthracite) coal use. The installation of a chimney in homes resulted in a substantial reduction in lung cancer incidence and mortality. Overall, our research underscores the need among existing coal users to improve ventilation, use the least toxic fuel, and eventually move toward the use of cleaner fuels, such as gas and electricity.
